Postprandial reactive hypoglycaemia in a very old patient

OBJECTIVE AND IMPORTANCE: Postprandial reactive hypoglycaemia (PRH) is a clinical syndrome characterized by the recurrence of symptomatic hypoglycaemia during postprandial periods. PRH remains a diagnostic challenge for clinicians, because of its atypical manifestations and low prevalence, especially in older persons. CLINICAL PRESENTATION: We report the diagnostic work-up of severe hypoglycaemic episodes in a very old patient in whom the diagnosis of PRH was made. INTERVENTION: We prescribed acarbose, an alpha-glucosidase inhibitor, to this patient to prevent the recurrence of hypoglycaemic episodes. Four years later, acarbose was always used and no further episode of hypoglycaemia had occurred. Based on the literature, we discuss the limited value of endocrine tests as well as the efficacy of the therapeutic approaches. CONCLUSION: Prescription of acarbose is useful in addition to nutritional education, the corner stone of the treatment, to avoid the recurrence of severe hypoglycaemic events due to PRH.